Achilles tendonitis
Achilles tendon inflammation differs from Achillodynia in the presence of inflammatory cells in the tendon itself. However, it can also be the result of an Achillodynia, for example when the degenerative changes cause an inflammatory reaction or when an inflammation spreads from the tendon sheath to the tendon. Achilles tendon inflammation also occurs more frequently in competitive athletes, especially runners.
The Achilles tendon inflammation manifests itself by the typical signs of inflammation: pain, redness, swelling, overheating and functional impairment. The temporal course of the occurrence of the symptoms is characteristic: They are particularly strong at the beginning and end of a strain, so during the strain there is relief. If it is an acute form, the complaints occur over a period of several days, usually triggered by a sudden increase in load (e.g. intensification of training).
In the chronic form of Achilles tendonitis, the complaints persist over a longer period of time, largely independent of the intensity of the load. However, climbing stairs or going uphill is often experienced as particularly painful. Also typical for an inflammation of the Achilles tendon are severe complaints in the morning after getting up.
The reason for this is that the tendon “stiffens” overnight. In some cases, small nodules can also be felt in the area a few centimeters above the tip of the heel. Occasionally, a crepitus in the area of the Achilles tendon can be heard during movement in the ankle joint, which is known as the “crepitus sign”.
Torn Achilles tendon
Although the Achilles tendon is the strongest tendon in the human body, spontaneous tears of the tendon can occur.In almost all cases, the tendon tears during high athletic stress, which is why young, athletic patients are particularly affected. The reason for this is that due to the heavy and regular strain, tiny injuries occur in the structure of the tendon, which can cause the tendon to eventually tear when the patient moves unluckily. However, a rupture can also occur in patients who are not active in sports: Due to their “sports abstinence”, the tendon is not accustomed to stress and is therefore more prone to rupture in everyday life, for example when falling down stairs or similar, than the “hardened” tendons of athletes.
Further risk factors are age-related degenerative changes in the tendon structure as well as the intake of certain drugs, such as various antibiotics or cortisone. A rupture of the Achilles tendon can usually be easily distinguished from the other possible causes of pain in the area of the Achilles tendon, since at the moment of the rupture, a bang that resembles a whip can often be heard. Immediately afterwards, strong, stabbing pain sets in.
It is characteristic that the patient is no longer able to stand on his toes or even walk with the affected leg. This is because the Achilles tendon is there to transfer the force of the calf muscles (which are responsible for stretching the foot towards the sole of the foot) to the foot. If the tendon is now torn, this transfer can no longer take place and the foot can no longer be stretched towards the sole of the foot, as is necessary for toe standing or walking.
The externally visible symptoms of a torn Achilles tendon are swelling and possibly bruising in the affected area. In addition, a dent can often be felt at the site of the tear. The diagnosis of an Achilles tendon rupture is based on the symptoms mentioned above.
A positive Thompson test is defined as the phenomenon when, in a patient lying on his stomach, an extension movement of the foot in the direction of the sole of the foot can no longer be achieved by squeezing the calf muscles – analogous to the toe position and gait that is no longer possible (see above). In addition to the clinical inspection, apparatus-based procedures can be used, especially ultrasound examination, but also MRI. They can confirm the diagnosis and also clearly show the extent and type of injury, which is relevant for the subsequent decision to be made between the available treatment options.
